Bill To:


Merry Elliott
1209 Beeblossom Drive
Desoto, TX 75115

Services Rendered To:


Merry Elliott
1209 Beeblossom Dr.
Desoto, Texas 75115
Policy # 66639539854


*** THIS HAS BEEN SUBMITTED TO YOUR INSURANCE COMPANY AND IGNORED. THIS IS NOW YOUR RESPONSIBILITY. ***

Product
Price
Qty
Amount
  1. 406 Medical Extrication – Lvl 2

    Patient:

    Merry Elliott
    1209 Beeblossom Dr.
    Desoto, Texas 75115
    Policy # 66639539854 

    $1,500.00
    1
    $1,500.00

  2. Additional Incident Info

    Incident Type: MVA Response

    Incident Location: 223 S.B. / Interstate 45 - Angus, Texas

    Ordinance Info: City of Angus Billing Authorization Item # 7

Subtotal $1,500.00
Total Due $1,500.00


Updated
March 11, 2021 @ 4:48 pm

Invoice updated by Geoffrey.

Updated
September 29, 2021 @ 5:28 pm

Invoice updated by Geoffrey.

Updated
September 29, 2021 @ 5:35 pm

Invoice updated by Geoffrey.